Abstract

Inflammatory cardiomyopathy (DCMi) is a specific cardiomyopathy entity of dilated cardiomyopathy (DCM), being defined by the proof of intramyocardial inflammation and/or viral infection in endomyocardial biopsies (EMBs). The immunohistological evaluation of EMBs, comprising the quantification of infiltrates and of cell adhesion molecule expression, has proven substantially more sensitive and specific compared with the histological EMB investigations according to the Dallas criteria. The molecular biological diagnosis of viral genomes comprises PCR for the qualitative evaluation, quantitative PCR for the determination of viral loads, and sequencing for the analysis of viral genotypes. By these techniques, DCMi has been detected in ca. 60% of the patients clinically presenting with either acute myocarditis (AMC) or DCM. DCMi assessed by immunohistology and viral persistence constitutes a prognostic factor for adverse outcome in AMC and DCM patients. Finally, this contemporary diagnostic repertoire is essential for the selection of DCMi patients who will likely benefit from immunosuppression or antiviral interferon treatment.